PURPOSE: This study was done to explore the levels of depression experienced by adolescents, and to compare health behavior between depressed and non-depressed adolescents. METHOD: Participants were chosen by a stratified random sampling of adolescents in the second grade of a high school in P city. Levels of depression and health behavior of the students were measured using questionnaires. Data collection was done in May, 2002. Data were analyzed with descriptive statistics and logistic regression using the SPSS WIN 10.0 Program. RESULTS: The prevalence of depression (CES-D) among the students was 53.5%. In multiple logistic regression analysis, sex (OR 1.80, 95% CI 1.35-2.41), school performance, mid (OR 1.68, 95% CI 1.48-1.97) and low (OR 1.42, 95% CI 1.29-1.61), drinking (OR 1.47, 95% CI 1.09-1.98), and not eating breakfast (OR 1.74, 95% CI 1.56-1.97) were significantly higher in students in the depressed group than those in the non-depressed group. CONCLUSIONS: Based on the findings, we concluded that many adolescent experience depression and depression in adolescents is significantly related to behaviors of smoking, alcohol, no exercise, and not eating breakfast. However this study did not address causality among these variables. There, further research, such as a longitudinal study, is needed to identify causality among the variables.
Adolescent* ; Breakfast ; Data Collection ; Depression* ; Drinking ; Eating ; Health Behavior* ; Humans ; Logistic Models ; Prevalence ; Smoke ; Smoking ; Child Health ; Surveys and Questionnaires

BACKGROUND: The use of a low-dose naloxone infusion concomitant with intravenous morphine PCA (patient-controlled analgesia) attenuates opioid-related side effects without reducing analgesic effects. The authors compared the incidence of morphine-related side effects and the quality of analgesia in adding low-dose naloxone, normal saline or droperidol to an IV fentanyl PCA regimen. METHODS: One hundred eight patients undergoing ocular plastic surgery were enrolled in the study. General anesthesia was induced and maintained with propofol TCI (target controlled infusion), vecuronium or pancuronium and nitrous oxide. After intubated, they received intravenous fentanyl as PCA. They were randomized to receive normal saline, droperidol or low-dose naloxone concomitant with IV fentanyl PCA. Verbal rating scores for pain, the degree of patients' satisfaction (1-4), nausea, vomiting, requests for antiemetics, urinary retention, pruritus and respiratory depression were recorded after 24 hours. RESULTS: There was no difference in the VRS (verbal rating score) for pain, degree of the satisfaction and the incidence of nausea, vomiting and requests of antiemetics among the three groups. There was no incidence of pruritus or respiratory depression. One subject developed urinary retention in the control group, and three cases in the droperidol group, but none was developed in the low-dose naloxone group. CONCLUSIONS: There was no difference in the prevention of postoperative nausea, or vomiting among the normal saline, droperidol, and naloxone groups with an IV fentanyl PCA. Low-dose naloxone, however, had a reducing effect on urinary retention; it may become an alternative choice according to the anesthesiologist's preference.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, General ; Antiemetics ; Droperidol ; Fentanyl* ; Humans ; Incidence ; Morphine ; Naloxone* ; Nausea ; Nitrous Oxide ; Pancuronium ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Propofol ; Pruritus ; Respiratory Insufficiency ; Surgery, Plastic ; Urinary Retention ; Vecuronium Bromide ; Vomiting

In order to investigate the incidence, clinical and microbiologic characteristics of Clostridium difficile infection (CDI) in Korea, a prospective observational study was performed. From September 2008 through January 2010, all patients whose stool was tested for toxin assay A&B and/or C. difficile culture were studied for clinical characteristics. Toxin types of the isolates from stool were tested. The mean incidence of CDI per 100,000 patient-days was 71.6 by month (range, 52.5-114.0), and the ratio of CDI to antibiotic-associated diarrhea was 0.23. Among 200 CDI patients, 37.5% (75/200) was severe CDI based on severity score. Clinical outcome of 189 CDI was as followed; 25.9% (49/189) improved without treatment, 84.3% (118/140) achieved clinical cure and attributed mortality was 0.7% (1/140) with the treatment. Recurrence rate was 21.4% (30/140) and cure without recurrence was 66.4% (93/140). The most common type of toxin was toxin A-positive/toxin B-positive strain (77.5%), toxin A-negative/toxin B-positive strains or binary toxin-producing strains comprised 15.4% or 7.1%, respectively. In conclusion, the incidence of CDI in Korea is a little higher than other reports during the non-epidemic setting. We expect that the change of epidemiology and clinical severity in CDI can be evaluated based on these results.
Aged ; Bacterial Proteins/analysis ; Bacterial Toxins/analysis ; Clostridium Infections/*epidemiology/physiopathology ; Clostridium difficile/*isolation & purification/*pathogenicity ; Diarrhea/epidemiology/microbiology ; Enterocolitis, Pseudomembranous/*epidemiology/microbiology/pathology ; Enterotoxins/analysis ; Feces/microbiology ; Female ; Hospitals ; Humans ; Incidence ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Prospective Studies ; Recurrence ; Republic of Korea/epidemiology ; Treatment Outcome ; Vancomycin/therapeutic use

BACKGROUND: Caudal block is useful when anesthesia for surgery or treatment for chronic pain is needed, but this procedure has a failure rate of up to 25% even when it performed byan experienced physician. This high failure rate is usually due to improper needle placement. METHODS: After gaining approval of the ethics committee, 46 patients received caudal blocks under ultrasound guidance; these were performed after the anatomical structures in the sacral hiatus had been measured with ultrasound. All these procedures were performed by the same anesthesiologist. The position and direction of the needle were identified using fluoroscopy by injecting a radio-opaque contrast through the needle. The time taken from thelidocaine injection to verification of the needle was measured and the planned nerve block was then carried out. RESULTS: All cases of needle insertion into the sacral canal under ultrasound guidance were successful. The average duration of the procedure and the trial count were 134.1 +/- 10.1 seconds and 1.2 +/- 0.1, respectively. In 12 of the 46 cases (26%), the needle deviated either left or right in the sacral canal, so the direction of the needle had to be adjusted. The distance between two cornua, the depth of the sacral hiatus and the thickness and length of the sacrococcygeal ligament were 17.1 +/- 0.4, 3.9 +/- 0.3, 2.3 +/- 0.1 and 24.9 +/- 0.9 mm, respectively. CONCLUSIONS: Ultrasound guidance can increase the success rate of inserting a needle into the sacral canal. However, even when ultrasound is used, the needle can deviate either left or right in the sacral canal.
Anesthesia ; Chronic Pain ; Ethics Committees ; Fluoroscopy ; Humans ; Ligaments ; Needles* ; Nerve Block ; Ultrasonography*

BACKGROUND: The blind sacroiliac joint (SIJ) block cannot always be performed accurately; it is commonly performed in the office based setting because intraarticular and periarticular injections are effective for SIJ pain. However, knowledge on the surface anatomy of the SIJ is lacking. The purpose of this study was to analyze the surface anatomical location of the posterior-inferior margin of the SIJ. METHODS: After informed consent was obtained, fifty patients undergoing SIJ block in the prone position were examined. The oblique angles where the anterior-inferior margin and the posterior-inferior margin of the SIJ overlap on X-ray were evaluated. In addition, the surface anatomical relationships between the posterior-inferior margin of the SIJ on X-ray and the posterior superior iliac spine (PSIS) and sacral hiatus by palpation were assessed. RESULTS: The oblique angle was 5.4 +/- 2.9degrees. The vertical and transverse distance between the posterior-inferior margin of the SIJ and PSIS were 3.8 +/- 0.8 cm and 0.9 +/- 0.6 cm, respectively. The vertical and transverse distance between the posterior-inferior margin of the SIJ and the midpoint of the sacral hiatus were 3.4 +/- 0.7 cm and 3.9 +/- 0.6 cm, respectively. Only the vertical distance between the posterior-inferior margin of the SIJ and PSIS showed significant difference between the male and the female groups (P = 0.0016). CONCLUSIONS: The measurements in this study can be used as a reference standards for the blind SIJ block.
Female ; Humans ; Informed Consent ; Male ; Palpation ; Prone Position ; Sacroiliac Joint ; Spine

A 57-year old woman presented with a complaint of pain on the left chest wall, incision scar area, axillae, upper forearm and limitation of motions at left shoulder for 4 years. She was treated under the diagnosis of postmastectomy pain syndrome. Pain was constrictive, myalgia in characters and the visual analog scale was 4. She said that the pain was worse when tired and fatigued, but relieved when in the bath. Associated symptoms were not found. A cervical epidural puncture (C6/7) was performed and 1% lidocaine with triamcinolone was injected. Gabapentin 300 mg daily was also given. Tender points injection with 0.5% bupivacaine and dexamethasone was performed several times. Stellate ganglion block with 1% lidocaine was also included once in the treatment regimen. On the second visit at the outpatient clinic, she showed fairly good signs of relief of pain and limitation of motions, but still remained anxious and complained of feeling of anger, frustration, and a feeling of loss and suffering. Hypnotic analgesia was indicated. Two sessions (1 hour for one session) were scheduled in a quiet room. Feelings of magnetic power on both palms were used as an induction technique and imagination on escalator was adopted for the deepening hypnosis, arm levitation for dissociation, a warm feeling of body for changing sensation, progressive relaxation, symbolic imagery for posthypnotic suggestion (turning the radio button) and glove analgesia technique were tried. Self-hypnosis and ego-strengthening were instructed for further pain relief. After the treatment, she was quite satisfied due to reduction of pain and stabilization of mind.
Ambulatory Care Facilities ; Analgesia* ; Anger ; Arm ; Axilla ; Baths ; Bupivacaine ; Cicatrix ; Dexamethasone ; Diagnosis ; Elevators and Escalators ; Female ; Forearm ; Frustration ; Humans ; Hypnosis ; Imagination ; Lidocaine ; Middle Aged ; Myalgia ; Punctures ; Relaxation ; Sensation ; Shoulder ; Stellate Ganglion ; Thoracic Wall ; Triamcinolone ; Visual Analog Scale

Twelfth rib syndrome is thought to be due to intercostal nerve irritation by a mobile twelfth rib, and presents with upper abdominal pain, or low thoracic pain. This syndrome appears to be a fairly common entity and diagnosis is based on clinical findings. Patients with twelfth rib syndrome can be misdiagnosed when it has been overlooked. We report a case of a 34-year-old male along with a presentation of twelfth rib syndrome. One patient was transferred from urologic clinic to pain clinic due to right flank pain and admitted. The patient had direct tenderness on twelfth rib area and direct tenderness was reproducible. Pain increased when the patient flexed laterally, rotated trunk. There were no specific abnormal findings in laboratory test, electrocardiogram, and radiologic examination. After intercostal nerve block and epidural block, pain decreased and the patient was discharged.
Abdominal Pain ; Adult ; Electrocardiography ; Flank Pain ; Humans ; Intercostal Nerves ; Male ; Pain Clinics ; Ribs

Facial blushing is a personally disabling condition, which can result in emotional disturbance and be an impediment to social life. Although numerous treatment options exist, including beta blocker, cognitive behavioral therapy and sympathetic neurolysis, no generally accepted form of treatment has been established. Herein, we report two cases of successful reduction of facial blushing following the administration of beta blocker and a minor tranquillizing antianxiety drug.
Affective Symptoms ; Blushing* ; Cognitive Therapy ; Humans

BACKGROUND: Selective diagnostic blocks of the medial branches of the dorsal primary ramus are usually performed under the guidance of fluoroscopic or computed tomography. Recently, however, ultrasound guidance has been suggested as an alternative method. In this study, the distances between the vertebral structures were measured and compared with the values measured using magnetic resonance imaging (MRI) to assess the clinical feasibility of using ultrasound-guided block in Korean patients. METHODS: Five male and 15 female patients were enrolled in this study. The target point of the medial branch block in our study was the groove at the base of the superior articular process. We measured the depth from the skin to the target point at the transverse process (d-TP) and to the most superficial point of the superior articular process (d-AP). RESULTS: The d-TP and d-AP values measured under ultrasound guidance were concordant with the values measured using MRI. CONCLUSIONS: The images of the bony landmarks obtained under ultrasound examination could be useful for ultrasound-guided lumbar medial branch block.
Female ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Skin ; Ultrasonography ; Zygapophyseal Joint

This report describes the successful treatment of spontaneous intracranial hypotension (SIH) with multiple cerebrospinal fluid (CSF) leaks using 10 applications of epidural blood patches (EBP). A forty year old female who suffered with a postural headache was diagnosed as having SIH. On the cisternography, multiple CSF leaks were noted at the thoracic and lumbar area. Her headache was not improved with conservative treatments such as bed rest, hydration and NSAIDS. So, she underwent treatment with EBPs. After 10 applications of site-directed EBPs, her headache was resolved gradually and completely without any complications.
Anti-Inflammatory Agents, Non-Steroidal ; Bed Rest ; Blood Patch, Epidural* ; Cerebrospinal Fluid ; Female ; Headache ; Humans ; Intracranial Hypotension*